甲状腺全切除术中对甲状旁腺特异性附着脂肪进行保护的临床和解剖研究

Clinical and anatomic study of preserving parathyroid specific adipose attachments in total thyroidectomy

目的 探讨甲状腺全切除术中甲状旁腺特异性附着脂肪的解剖学特点及其对甲状旁腺功能的保护作用.方法 前瞻性分析2015年1月至11月91例在北京医院普外科接受甲状腺全切除术患者的临床资料,男性19例,女性72例,年龄25 ～ 74岁,平均年龄（52±12）岁.利用术前超声、术中高清图像分析、术后病理检查记录甲状旁腺微血管结构的分布来源和特异性附着脂肪的特点.术中均使用甲状旁腺特异性附着脂肪保护技术,采用配对t检验比较手术前及术后1个月患者甲状旁腺素、血钙和血磷的变化.结果 术中对20例患者进行了甲状旁腺分析,共发现62枚甲状旁腺,其中48枚（77.4％）具有特异性附着脂肪结构.局部微血管结构与甲状旁腺及其附着脂肪关系密切.纳米碳淋巴示踪技术可以区分脂肪周围的淋巴结构,以利于更好地识别甲状旁腺特异性附着脂肪.应用附着脂肪保护技术进行甲状腺全切除术,患者术后1个月甲状旁腺素、血钙和血磷分别为（30± 16） ng/L、（2.20±0.14） mmoL/L和（1.26±0.25） mmoL/L,与术前的（39±17） ng/L、（2.23±0.10）mmol/L和（1.27±0.20）mmol/L相比差异无统计学意义（P＞0.05）.结论 甲状腺全切除术中采用特异性附着脂肪保护技术可以更好地保护甲状旁腺的正常微血管结构及其功能,有利于甲状旁腺的原位保护和功能恢复,可减少永久性甲状旁腺功能减退的发生.

Objective To discuss the anatomical characteristic and important role of specific adipose attachments in preserving parathyroid function in total thyroidectomy.Methods Parathyroid glands of 91 cases underwent total thyroidectomy in Department of General Surgery,Beijing Hospital from January to November 2015 were observed prospectively.There were 19 male and 72 female patients,aging from 25 to 74 years with an average age of （52 ± 12） years.Preoperative ultrasound examination,analysis of intraoperative high definition images,and postoperative pathological examination were used to detect the origins of the parathyroid micro vascular structures and the characteristics of parathyroid specific adipose attachments.Parathyroid specific adipose attachments preserving technique was used in all procedures.The results of parathyroid hormone （PTH）,serum calcium and phosphorus were compared pre-and 1-month post-operatively.Paired t test was statistically used to analyze data.Results Parathyroid micro vascular vessels were closely attached to parathyroid,and they were mainly originated from inside and （or） outside thyroid.Twenty patients received intraoperative high definition images analysis,62 parathyroids were detected,in which 48 parathyroids （77.4%） had its specific adipose attachments.Lymphatic tissues could be distinguished from adipose tissue using carbon nanoparticles lymphatic tracer technique,which resulted in better preservation of parathyroid specific adipose attachments.There was no significant difference in PTH （（39± 17） ng/L vs.（30± 16） ng/L）,serum calcium （（2.23±0.10） mmol/L vs.（2.20±0.14） mmol/L） and phosphorus （（1.27±0.20） mmol/L vs.（1.26±0.25） mmol/L） pre-and 1-month post-operatively （P〉 0.05）.Conclusions Preservation of parathyroid specific adipose attachments in total thyroidectomy could result in better protection of parathyroid micro vascular structure and function.It could be benefit to preservation of parathyroid in situ and its funetion recovery,thus may reduce the incidence of permanent postoperative hypoparathyroidism.